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General NPI Number Information
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NPI Number | 1811379043
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Entity Type | Organization
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Legal Business Name | TENERY OPTICAL, LLC
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Dates
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Enumeration Date | 06/24/2015
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 7777 FOREST LN B424
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City | DALLAS
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State | TX
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Zip | 75230-2571
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Country | US
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Telephone | 972-566-8250
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Fax |
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Provider Business Mailing Address
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Address Line | 7777 FOREST LN B424
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City | DALLAS
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State | TX
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Zip | 75230-2571
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Country | US
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Telephone | 972-566-8250
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Fax |
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Authorized Official
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Title or Position | SEC/TRES
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Name | MR. ROBERT WEBSTER UPTON
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Credential | ABOC
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Telephone | 972-566-8250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | DR4071
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License Number State | TX
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